What type of programming do we need?

We are looking for programming where as a customer would sign-up for one of our advertising/promotional packages and then:
1)Asked to agree to specific terms.
2)Taken to a specific form where questions about the Indie shop their promoting will be displayed as well as a request for an image.
3)The text that they have entered in the form is automatically entered into a web page, either for immediate publishing or for publishing down the road, within a certain format.
4)The image is also automatically entered into the format of our directory.

We need a low cost method of accomplishing this and also would like to be able to speak intelligently about the type of programming that we need.